One hundred and forty-four cases of hepatoma were observed during the past 8 years and the way of reaching the diagnosis in these cases were analyzed. The 8 years' period of investigation was divided into 2 parts, the early and the late period, namely, before and after the advent of linear electric ultrasonic scanner.
In the early period (71 cases), the main diagnostic methods for hepatoma were mainly alpha-fetoprotein (AFP) and isotope scanning (RI), so the early detection of hepatoma was very difficult. But, in the late period (73 cases), important diagnostic tests including ultrasonic scanning (US), computed tomography (CT) and celiac angiography (Angio. ) were easily available, so the detectability of hepatoma was markedly improved.
The most useful test for the screening of hepatoma was US because of its simplicity and good sensitivity, the most sensitive method was lipiodol-CT that was CT examination after an intra-arterial injetion of lipiodol since the lipiodol was selectively accumulated in the nodule of hepatoma, and the most reliable pathological examination before the treatment was US guided aspiration cytology. In other methods, AFP was a useful tumor marker if it showed an abnormal level, but it should be remembered that AFP was within normal level in about 20% of hepatoma patients. RI was less useful for hepatoma, espe-cially in its early stage because of its unfavorable sensitvity.
Using these diagnostic methods, 24 cases with small hepatoma (5-3cm: 13 cases, 3cm>: 11 cases) were detected in the late period, but the fact that 33% of these cases were detected as multinodules should be born in mind for the therapy.
Now, the diagnostic methods for hepatoma was established in our hospital, and the patients with chronic liver disease and HBsAg carrier were at high risk for hepatoma

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The diagnostic criteria of adenosquamous cell carcinoma (ASCa) is controversial. The authors consider that formation of cell nest, arrangement of mosaic pattern (Mp), kera-tinization and intercellular bridge are essential to the diagnosis of ASCa.
Seven hundred and seventy nine cases of gastric cancer and 13 cases of esophageal carcinoma have been resected in Kyoto National Hospital. Histological investigations are done.
To date, 140 cases of ASCa have been reported in the Japanese literatures. These reports are reviewed. Conclusions obtained are as follows:
1) Keratin staining is done in 13 cases of esophageal carcinoma. Either keratin or prekeratin is recognized in all cases.
2) Thirteen cases out of 779 gastric carcinoma are suspected of ASCa. These cases show the cell nest formation which is characteristic of ASCa.
3) Either keratin or prekeratin is recognized in 5 out of 13 cases of suspected ASCa (38.5%).
4) Mp is seen in 5 cases in which keratinization is shown.
5) In 97 (69.5%) of these cases whether keratin is present or absent is described. In 69 cases, Keratinization is recognized. Only in 41 (29.3%) of 140 cases, whether Mp is present or absent is recognized.
6) According to the diagnostic criteria of the authors, the incidence of ASCa in this hospital is 0.6% of gastric carcinoma. The diagnostic criteria of the authors is fulfilled in only 69 out of 140 cases of ASCa reported in the Japanese literatures

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Eighty six patients who died of gastric cancer were examined at autopsy. They were classified into 3 groups-34 recurrent cases after gastric resection, 10 non resectable cases and 42 non operative cases. Modes of recurrence were analysed based on the comparison between the operative findings and the autopsy findings. Following observations were made.
1) Recurrence of antral cancer was noted in the subhepatic region.
2) Modes of recurrence were not related to the operative procedures.
3) Non-curative operation was frequently caused by severe local recurrence.
4) Severe peritoneal dissemination was most frequently caused by poorly differentiated adenocarcinoma.
5) Recurrence in the liver was not correlated with the histological type of the primary cancer.
6) In cases autopsied within 1 year following operation, severe recurrence of perito-neum, liver, lung and pleura were fouud.
On the other hand, in cases of more than 3 year-survival at autopsy, anastomosal recurrences were most frequently seen.
7) Nine cases in which surgical cut ends were free from cancer, had anastomosal recurrences at autopsy.
8) Recurrence in the lung with no liver metastasis was always accompanied with the remarkable pleural dissemination

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In order to improve the visualization of the pancreatic arteries, selective celiac or superior mesenteric arteriographic examinations were performed in sixteen patients by means of using injection of contrast material distal to occlusion of celiac trunk or SMA with a balloon-tipped catheter. With use of these techniques, precise information of the pancreatic arteries, comparable to that of superselective pancreatic arteriography, were obtained in sixty percent of all the pancreatic arteries.
In addition, left gastric artery, which sometimes cannot be separated from the pancre-atic arteries on X-ray films, was occluded in about half of the cases, so that fine visuali-zation of the pancreatic arteries was obtained.
These techniques were confirmed to be safe and simple, so they may provide fine visualization of the pancreatic arteries, even when superselective pancreatic arteriography cannot be done

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We measured serum and urine sialic acid (SA) in 52 cases of chronic renal diseases during childhood and the following results were obtained.
1) Serum SA levels were high in the active stage of steroid sensitive nephrotic syn-drome (SSNS) and became normalized in the remission stage. Some cases in the nephrotic stage of membranoproliferative glomerulonephritis (MPGN), focal glomerular sclerosis (FGS) and chronic glomerulonephritis (CGN) showed high SA levels. Patients with per-sistent glomerulonephritis (PGN) showing high serum SA level had moderate proteinuria or frequent attacks of infection. In nephropathy associated with Wilson disease, serum SA levels were low, on the other hand in a case of hepatic glomerulosclerosis, that was high.
2) Urine SA levels were high in 3 cases of SSNS, 1 case of MPGN, 1 case of CGN, 2 cases of PGN and 1 case of Debre de Toni Fanconi Syndrome and these cases had massive or moderate proteinuria, or reduced renal functions.
3) In one case of PGN serial measurements of the SA level during fibrinolytic therapy demonstrated low SA level in the urine during the early stage of the therapy.
It seems that the serial measurements of serum and urine SA levels are useful in assessing the disease condition of chronic renal diseases

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A case of diabetes insipidus associated with ulcerative colitis has not been reported yet. A 56-year-old man with diabetes insipidus had been treated with clofibrate and trichlorme thiazide for about three years since March 1971.
He was admitted to our hospital on December 15, 1978 because of diarrhea, thirst, general malaise, anorexia and a weight loss of 10kg. At the time of admission, the body temperature was 37.5°C and the average volume of urine per day was 3.7 liters. The skin was dry, marked anemia was present and the total serum protein was 5.0g/dl. Liver function and immunoglobulin levels were normal. There was an increase in the erythro-cyte sedimentation rate. A tuberculin skin test was negative and the functions of endo-crine glands (anterior pituitary gland, thyroid gland, and adrenal cortex) were all normal.
Ba enema, endoscopic examination and the biopsy of the colon revealed severe idio-pathic ulcerative colitis in all areas of the colon.
Five μg of DDAVP was administered twice as nose drops, and the volume of urine was decreased to about 1.5 liters per day. Administration of Salazopyrin resulted in disap-pearance of the diarrhea, improvement of the anemia, and normalization of total serum protein. It is considered that idiopathic ulcerative colitis is an incidental complication during the course of diabets insipidus

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We checked HLA antigens in order to study the immuno-genetic relations in the in-flammatory bowel diseases (IBD). The study was done on seven patients, including four cases of ulcerative colitis (UC), two cases of Crohn's disease (CD) and one case of intes-tinal tuberculosis (TB) who were treated in our hospital.
The typing of A, B and C antigens was made after the NIH standard method using commercially available “HLA-A, B, C plate HS” by Hoechst Japan KK, Tokyo.
Three out of four cases of UC had AW 24 and CW 3 and two cases demonstrated A 11 and BW 52. Two cases of CD had only CW 3. One case of TB had AW 24.
These results suggested that AW 24, CW 3, A 11 and BW 52 were important in UC. There were no specific findings in CD and TB except for CW 3 and AW 24 respectively. We would like to continue this study and to collect more data in the future

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We operated on 2 cases of the malignant duodenal tumors which are said to be very rare.
The first case was a 65-year-old man who had carcinoma of the fourth portion of the duodenum. Operative method was a partial resection of the duodenum and the jejunum with end-to-end anastomosis. The patient died about 3 years after the operation due to the recurrence of the tumor.
The second case was duodenal leiomyo-sarcoma seen in a 47-year-old man. The tumor was located in the middle of the descending part of the duodenum and it was extir-pated by pancreaticoduodenectomy. It was as large as the head of the children. This case also died about one year and 2 months following the operation because of the recur-rence.
We reviewed the literatures about the malignant tumors of the duodenum including our 2 cases

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It is well known that the intestinal diseases including tuberculosis, Crohn's disease, Behçet disease, diverticulitis may cause the ulceration of the small intestines. We experi-enced a patient with iliac trouble, which was not related to any of the above diseases. The patient developed ulcers without any ulcerogenic factors such as foreign substances, exposure to radiation, and the drugs which might have the possibilities of making fistulas and an abscess in the Douglas pouch.
A 33-year-old male patient had experienced ileocecal pain twice which had been cured by antibiotics. Because of the third occurrence of the pain, he was hospitalized in No-vember 1982. The stenotic portion of the terminal ileum which was about 20cm from the ileocecalic valve was observed by barium enema. The operation was performed on December 14th 1982. At the operation, a lumped terminal ileum caused by inflammatory adhe-sion and an abscess formation from the ileum toward the Douglas pouch were found. Ileocecal resection and the drainage from the abscess were performed. In terms of the detailed examination of the resected specimen, two ileo-ileal fistulas were discovered at 20cm and 60cm from the ileocecalic valve. It was, therefore, suggested by histopa-thological and clinical findings that the two fistulas had been made by the perforation of and the penetration into the adjacent ileum from the primary non-specific ulcers of the small intestine. Although one year and a half have passed, no recurrent symptoms have been observed

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Tumor associated antigens (TAAs) are frequently detected in patients with malignant tumors of the digestive system. It is very rare, however, that many TAAs are detected simultaneously in the same patient. We experienced a case of gastric cancer with four TAAs elevated in the serum, so we report this case including the histological studies by the peroxidase anti-peroxidase (PAP) method.
A 53-year-old male patient was admitted to our hospital with a chief complaint of right hypochondralgia. This patient was operated on subtotal gastrectomy on Jun. 8 '81 due to early gastric cancer. This cancer was macroscopically IIc+ III type, mainly moderately differentiated adenocarcinoma on histology and had already metastatized to the lymph nodes. Metastatic liver cancer was found by close examinations in Nov '82. The laboratory examination on this admission showed AFP 15388ng/ml, CEA 4.50ng/ ml, β₂-microglobulin 1.41μg/ml, ferritin 377ng/ml etc., and these levels became gradually elevated in the follow-up period. He died on Mar. 11 '83 and his autopsy disclosed metastatic tumor of the liver, the lung and so on. We stained the TAAs by the PAP method and AFP, CEA and ferritin were detected in the cancer cells

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A 56-year-old man with thoracic empyema and multiple liver abscess was reported. He had visited Korea in June 1983 and had mild non-bloody diarrhea since then. He was admitted to our hospital on July 19, 1983, with a three-weeks history of right-sided the pain, high-fever, cough and sputum. Chest roentgenograms showed a right pleural effu-sion. The pleural aspirates was bloody-purulent effusion, but the culture was negative for microorganisms. Antibiotic therapy with clindamycin phosphate and amikacin was started for a presumed bacterial thoracic empyema. On the fifth hospital day, he com-plained of right upper quadrant pain. His abdomen became distended and hepatomegaly was noted. An ultrasound examination of the liver showed multiple abscesses in the liver. Based on the clinical information, though amebic cysts were not seen in a fresh stool and pleural aspirates, a presumptive diagnosis of amebic abscess was made, and the patient was treated with metronidazole. However, he died on the tenth hospital day by the fatal liver dysfunction. The serum indirect fluorescent antibody test for amebiasis was positive at a titre of 1:512. Agar gel diffusion test of serum and pleural effusion was positive for amebic antigen

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This is a case of 9-year-old female, who developed sudden onset of left epigastric pain and vomiting when getting up early in the morning, and was admitted to a clinic in the neighborhood. However, abdominal pain increased with fever and leukocytosis, and on the next day she was transferred to our hospital. On admission, the leukocyte count was 17, 900 and the body temperature 37.7°C.
A tumor was palpable in the left epigastric region and the peritoneal irritation symptoms were present. The ultrasonography revealed a solid tumor corresponding to this site, and furthermore an image of vascular invasion was seen from the lower surface of the central part of the tumor, and it was assumed to be the spleen. Based on these findings, an emergency laparotomy was performed on the same day. Operative findings revealed a gigantic congestive spleen with the absence of various bands fixing the spleen, and the spleen was in torsion more than 180° around the axis of the splenic hilus. Splenectomy was performed.
Immediately after the operation a transient increase in platelet count was seen, as well as increases in platelet aggregation and adhesion, but 1 year and 6 months after the operation no particular abnormality is noted at present

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Two cases of renal artery aneuysm were reported.
The first case was a 63-year-old woman who was admitted with the chief complaint of hypertension. Her blood pressure was 150/100 mmHg and plasma renin determinations from the right and left renal veins and the inferior vena cava were within normal limits. A scout film of the abdomen showed two calcific ring shadows in the right renal region. Abdominal aortograms revealed two saccular aneurysms, one in a major branch and the other in a intrarenal branch of the right renal artery. Right nephrectomy was performed. but her blood pressure remained elevated.
The second case was a 65-year-old woman who was admitted with the complaint of pain in the left lumbar region and the right shoulder. Her blood pressure was 170/100mmHg. A plain film of the abdomen showed a ringform calcification in the upper pole of the left kidney. Intravenous pyelograms demonstrated a calcified shadow at upper calyx of the left kidney, and an incomplete reduplication of the left renal pelvis and the ureter.
Left nephrectomy was performed under the diagnosis of left renal stone. But pathological examination revealed a renal artery aneurysm.
Her blood pressure became normal after the operation. Diagnosis and surgical indi-cations of renal artery aneurysm were discussed with a review of the literature

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The patient was a 33-year-old male. Family history and past history were non-con-tributory. He has been healthy until a periodic medical examination in 1982, when prote-inuria was pointed out for the first time. On July 16, 1982 he consulted Department of Internal Medicine of this hospital, and proteinuria, microscopic hematuria and hypertension were noted without a tumor or pain in the renal region. In order to rule out renovascular hypertension, a renal scintigram and renogram were obtained. The former showed a defect in the upper part of the right kidney, and he was hospitalized on August 10, 1982 for further examination.
On physical examination, he was 174cm in height, 79.5kg in weight, nutritional state was good without anemia or fever. Blood pressure was 150/110mmHg without any differences between right and left sides, there was no swelling of superficial lymph nodes, and no abnormal findings in the thoracic and abdominal regions and no neurological findings were found. Laboratory tests revealed erythrocytes count of 499×10⁴, leukocytes count of 6, 100 and no abnormalities for differential counts. Platelet count was 172, 000. Urine specific gravity was 1, 027. Proteinuria of 0.51‰ with negative glycosuria was noted. Urinary sediments demonstrated 2-3 erythrocytes, and 8-10 leukocytes without any cylinders. The results of blood chemistry were as follows : BUN: 15mg/dl, creatinine: 1.14mg/dl, uric acid: 4.5mg/dl, total protein: 6.2g/dl, serum cholesterol: 178mg/dl, Al-p: 4.5 u, LDH: 258 u, erythrocyte sedimentation rate: 5mm/hour, CRP(+), and normal plasma renin activty. PSP was 35.8% for 15 min. A plain film of the abdomen and pyelography by elimination showed no compression or defect due to a tumor in the pelvis or calyx, while renal CT revealed a relatively clearly limited circular part of low absorption behind the right kidney. The selective renal arteriography demonstrated a circular tumor of 3.5cm in diameter in the upper part of the right kidney, but no char-acteristic images of the retention of the contrast medium was found in the tumor area in the arterial or venous phase.
However, tentative diagnosis of renal tumor was made and right nephrectomy was performed on September 3 in the Department of Urology of this hospital. There was no swelling of the lymph nodes in the hilus of the kidney or around the vena cava. Histo-pathologically it was a clear cell carcinoma with the renal parenchyma and the tumor was clearly demarcated by connective tissue. The postoperative course was satisfacotry, and the patient was discharged on September 26. At present he is followed-up in the outpa-tient clinic, and no recurrence or remote metastasis are noted. Since there are many renal lesions showing an avascular image on renal angiograms including cancer, cyst, tuberculosis, carbuncle, perinephric abscess it is important to differentiate those lesions. A case of avascular renal cell carcinoma (clear cell carcinoma) that was detected in its early stage was reported

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A 61-year-old woman visited our hospital because of epigastric discomfort. X-ray and endoscopic examination revealed submucosal tumor in the lower part of the gastric body. Gastrectomy was performed and histological examination revealed a lipoma in the submucosal layer.
Gastric lipoma is a rare submucosal tumor. It is difficult to differentiate the submucosal lipoma from the other tumors such as cyst or myogenic tumor

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Recently three cases of double early gastric carcinoma were observed in our hospital and those are presented.
Case 1-The patient was a 60-year-old man. Cancer of Borrmann Type III was detected on the posterior wall of the gastric angle and of Type IIc on the anterior wall of the body; diagnosis of double gastric carcinoma was made. On May 30, 1978, subtotal gast-rectomy was conducted. Reconstruction was perfomed using Billroth Method I.
Pathological specimens showed Borrmann Type III (pm, tub₂+por) carcinoma on the posteriorl wall of the gastric angle and Type IIc+ III (m, tub₁) carcinoma on the anterior wall of the body.
Although the postoperative course had been favorable, an early gastric carcinoma Type IIa was found in the remaining stomach on medical examination in September, 1981. The patient underwent a total gastrectomy (Roux-Y) of the remaining stomach on December 1, 1981. An early gastric carcinoma Type IIa was found in the lesser curvature by patholo-gical examination. The lesion reached sm; the tissue type was tubs.
Case 2-A 48-year-old man was diagnosed as having a benign ulcer of the gastric angle and a Type IIc carcinoma on the posterior wall of the body. Subtotal gastrectomy using Billroth Method I was conducted on June 29, 1982. Since a tumor was found in the ascending colon during the surgery, the right half of the colon was also resected.
Pathological specimens showed Type TTc (sm, tub₁) carcinomas of the gastric angle and on the posterior wall of the body and Borrmann Type II (ss, mucinous carcinoma) in the ascending colon.
Case 3-A 78-year-old man was diagnosed as having Borrmann Type III carcinoma in the antrum. Gastrectomy was performed using Billroth Method I on November 4, 1982.
Pathological specimens showed carcinoma of Type tta+ ttt (sm, tub₁) in the antrum and that of Type IIa (m, tubs) on the anterior wall of the lower stomach body.
It is reported that the incidence of double early gastric carcinoma among all early gastric carcinomas is about 10%, therefore double early gastric carcinoma is not so uncommon as is expected.
However, as shown in the cases we experienced, preoperative diagnosis of double early gastric carcinoma, as well as identification and qualitative diagnosis, is very difficult.
Thus, these cases suggested the difficulty in making a correct diagnosis and the literatures were reviewed.

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The patient was a 43 year old male with an intractable cancer. He was a technical staff member of a printing company, with a speciality of producing silk screens. For about two years since the gastric cancer was relapsed, the patient produced 50 prints of silk screen. He asked his physician to make psychological analysis through his works and died in June, 1981. His posthumous works could be divided into four stages by the coloring technique used and the images they gave.
The first stage was a period when the relapse of cancer was suspected in him. The background of the pictorial compositions was colored in light blue, no objective depictions were seen but mostly abstract, e.g. cloud-like objects soaring towards the sun. Evinced in the works were positiveness and vigorousness which was also representing inwardly his ‘anger’ toward the illness afflicting him.
The second stage was a period when his tumor was growing. The background of his works was, colored grey representing his depressive mood and uneasiness, and the pictures of cities, automobiles, motorcycles, electrical applicances, etc. were all covered by haze-like patterns. Touches of actuality and consciousness were seen in his works, but expres-sions of ‘denial’ was hidden behind them.
The third period was when the patient was told of the diagnosis of the disease he was suffering. The background of his works were in navy-blue color. The colors used in a loud tone were pink of gentleness and white of holiness. Depicted were the people in his reminiscence, moon, sun, helmet, birds and a soul-like objects flying up from the earth. Psychologically, a trend of his ‘depression’ was symbolized.
The fourth stage was the three months before the patient was hospitalized again when his systemic symptoms were exacerbated. The background of his works was colored dark. The conspicuous colors used were green and pink. In the panoramic views depicted were feather-like objects fluttering in the sky, the lifeline running horizontally, birds, sun, etc. ‘Acceptance’ of death even in a depressed mood could be sensed there.
In the processes of anger, denial, depression and acceptance, the patient appeared to have accepted death and departed from this world peacefully as his mental condition was symbolized by the colors of pink and green, birds, and the sun

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